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Hertfordshire COVID-19 Local Outbreak Plan Version 1.9.5 July 1st, 2020
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COVID-19 Hertfordshire Local Outbreak Plan
Version 1.9.5 July 13th, 2020 Jim McManus Director of Public Health Hertfordshire County Council County Hall Pegs Lane Hertford SG13 8DE [email protected]
APPENDIX B
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Version Control Table (From Version 1.9)
Version Number
Date Amends Signed Off
1.9 30TH June 2020 New version produced following half day public health team meeting
JMcM
1.9.1 30th June 2020 Placement of Appendix of Legal Powers
JMcM
1.9.2 1st July 2020 Agreement with District and Borough Reps on content of expectations of their roles
JMcM
1.9.3 2nd July 2020 Updates of roles and expectations JMcM
1.9.4 9th July 2020 Updates of roles after discussion with district colleagues, new data flow diagram, corrections and amendments from Districts and Boroughs
JMcM
1.9.5 13th July 2020 Comments received from district and borough colleagues
JMcM
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Contents
List of Tables .............................................................................................................. 4
List of Figures ............................................................................................................. 4
1. Context and Purpose .............................................................................................. 5
2. Aims and Objectives ............................................................................................... 6
Outbreak Levels including a Second or subsequent Wave ..................................... 7
3. National and Local Responsibilities ..................................................................... 8
Summary of Leads in our Outbreak Plan .............................................................. 10
What we expect from every agency and stakeholder ........................................... 14
3. Priorities and Programmes ................................................................................... 20
4. Programme 1: Prevent and Respond ................................................................... 21
5. Programme Two: Testing and Contact Tracing .................................................... 39
National and Local Roles ...................................................................................... 39
6. Programme Three: Surveillance, Intelligence and Data .................................... 45
7. Programme Four: Engaging Communities ....................................................... 50
8. Programme Five: Governance and Programme Co-Ordination ....................... 53
Appendix 1: Member Engagement Board Terms of Reference ................................ 60
Appendix 2: Health Protection Board Terms of Reference ....................................... 62
Appendix 3: Legal Powers to enforce actions required in managing Outbreaks ...... 66
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List of Tables
Table 1: Levels of Outbreak Alert ............................................................................... 7 Table 2: Complementary Roles at National and Local Level ...................................... 9
Table 3: Programme and Workstream Leads ........................................................... 10 Table 4: Key expectations of each agency .............................................................. 14 Table 5: Workstreams in Prevent and Respond Programme ................................... 20 Table 6: Priorities and Key Actions for Prevent and Respond Workstreams ............ 22 Table 7: Priorities and Key Actions for Testing and Contact Tracing Workstreams . 41
Table 8: Priorities and Key Actions for Surveillance and Data Workstreams ........... 47 Table 9: Priorities and Key Actions for Communications Workstream ..................... 51 Table 10: Priorities and Key Actions for Governance and Programme Co-ordination Workstreams ............................................................................................................ 55
List of Figures Figure 1 Outbreak Planning Framework for Hertfordshire .......................................... 5 Figure 2: National Test and Trace System ................................................................. 8 Figure 3: Data Flows for Outbreak Management ..................................................... 46
Figure 4: Reporting and Governance Arrangements ................................................ 54
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1. Context and Purpose On 22nd May 2020 Government announced that as part of its national strategy to reduce infection from COVID-19 it would expect every area in England to create a local Outbreak Plan. Government expects that local plans, led by the Director of Public Health, will be produced by the end of June 2020. National Guidance was issued jointly by Public Health England with five key partner agencies. This Local Outbreak Plan builds on existing health protection plans and put in place measures to contain any outbreak and protect the public’s health. The Director of Public Health is responsible for defining the measures required to do this. This plan is intended to enable agencies in Hertfordshire to prevent, manage, reduce and suppress outbreaks of COVID-19 infection across the County. This plan sets out the arrangements for surveillance of and response to local outbreaks and infection rates. Some of these (such as work in Care Homes) are already in Place. Other parts (such as how the National and Local Contact Tracing Systems interface) are still being developed nationally. The plan identifies aims, objectives, workstreams and the appropriate governance and responsibilities for each of those. The Outbreak Planning framework for Hertfordshire consists of two layers, as outlined below. This plan, which is intended to provide a straightforward and transparent summary accessible to everyone, and detailed plans for each Programme and Workstream. Figure 1 Outbreak Planning Framework for Hertfordshire
Overarching Plan
(This document)
Detailed Programme Plans for Each Programme and Workstream
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2. Aims and Objectives The aims of the Local Outbreak Plan are
1. to protect the health of the population of Hertfordshire from COVID-19 through preventing the spread of COVID-19 and associated disease through
a. Preventing spread of Covid-19 across workplaces and communities using best
available tools and evidence i. Ensuring data and surveillance systems are in place to enable
intelligence-led prevention and outbreak management ii. Systematically identifying populations and settings at higher risk in
terms of spread and vulnerability to the effects of COVID-19 when infected
iii. Establishing effective prevention strategies for these settings and populations
b. Identifying outbreaks as early as possible c. Containing and suppressing outbreaks by proactively using best current tools
and evidence d. Co-ordination of the capabilities of all relevant partners e. Agreement of. roles and responsibilities and escalation routes across the
tiers/organisations i. Establish systems and workforce capacity to effectively respond to
outbreaks for these cohorts f. Defining governance, roles and responsibilities for all stakeholders and
command & control arrangements relating to Covid-19 management g. Where possible support incorporation of Covid-19 response into existing
structures and ways of working h. Ensure that arrangements for preventing and managing non COVID-19
seasonal communicable diseases which may impact adversely on public service capacity are in place (e.g. seasonal vaccination campaigns for ‘flu and other diseases for residents and key workforces [e.g. social care and NHS].)
2. To assure the public and stakeholders this is being effectively delivered by
a. Publication of our Local Plan b. Establishment of a Member-Led Governance Board c. Setting out communications and engagement arrangements with partner
organisations and residents d. Proactive and reactive communications campaigns and resources designed to
enable residents and stakeholders (businesses, schools etc) to take action e. Produce epidemiological surveillance and modelling to support action f. Communicating clearly to residents when action is being taken and why g. Using Programme Management Principles and Capabilities
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Outbreak Levels including a Second or subsequent Wave An outbreak of COVID-19 is defined in national guidance (June 2020) as two or more linked cases of COVID-19 in any given setting within any twenty-eight-day period. (The two must be linked to the same school, home, workplace or healthcare setting.) Health Protection arrangements already exist for managing Outbreaks of infection in Hertfordshire. What is different about COVID-19 is the scale, which was so significant in the period March 2020 – June 2020 that it required the Strategic Co-ordinating Group of the Local Resilience Forum to co-ordinate activity. In developing this Outbreak Plan we have identified levels of Outbreak alerts for the system from 1 to 4. This plan is designed to cope with Level 1 and 2 Outbreaks. Level 3 would require a Major Incident to be declared. Level 4 would essentially be a Second Wave of the Pandemic which would require the SCG to be fully operational. The levels of alert are shown below.
Table 1: Levels of Outbreak Alert
Level Characteristics Recent Examples
1 Outbreaks within existing capacity, even if in multiple settings simultaneously. The Health Protection Board would manage these
COVID 19 in Care Homes and Schools
2 Outbreaks which exceed existing outbreak management capacity and need additional resource or capacity. The Health Protection Board and SCG would work together
Lookback exercises and screening on over 1500 people (multi agency response)
3 Outbreaks which exceed existing capacity and require the SCG and/or one or more partners to declare a Major Incident
‘Flu Season 2017
4 Second Wave A second wave of infection as bad or worse than the first which requires full scale SCG Co-ordination and National Response
COVID first wave
As part of our arrangements to manage local outbreaks we have specified Surveillance and Epidemiology functions which will ensure we have early warning of Outbreaks heading to level 3 or Level 4 (Second Wave) in order to plan. The Board will keep under review the Outbreak levels and capacity levels. A response level dashboard for the SCG on response levels has been created. This will be one of the sources we use in monitoring response – with an additional daily dashboard - so SCG and Health Protection Board have the same understanding of response
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level. These will be at Hertfordshire level but enable people to drill down to the lowest level we can make available (MSOA potentially.)
3. National and Local Responsibilities The UK Government has set out four key strands to the national approach to tackling Covid-19: test; trace; contain; and enable. These have distinct but complementary roles at national and local level. Figure 2: National Test and Trace System
The purpose of this system is to control the Covid-19 rate of reproduction (R), reduce the spread of infection and save lives. To control the rate of reproduction three tiers of operation have been implemented nationally. Local planning and response is an essential part of the operation and forms part of level 1b, a Local Outbreak Control Plan is required to document these local plans.
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Table 2: Complementary Roles at National and Local Level
The role of NHS Test and Trace (National)
The role of the Local Outbreak Plan
What
A central part of Government recovery strategy seeking to control the spread of the virus through well tried testing, isolation and contact tracing.
Web-based tool Contact Tracing and Advisory System (CTAS)
Phone Based Contact Tracing (PBCT) Teams with a dedicated contact tracing service comprising professional staff employed through NHSP (Tier 2) and a call handler force supplied through a commercial provider (Tier 3).
PHE Local health protection teams (Tier 1a and one part of Tier 1b) (HPTs) and the field service (FS) teams delivering their usual responsibilities of investigation and control of complex outbreaks and situations
What A Locally led multi-agency partnership to
prevent, identify and contain local outbreaks
Working with Local PHE Centre, East of England ADPH and neighbouring authorities on common priorities and shared processes
Prevention
The Seven Themes set out by Government
The local delivery of the outputs from NHS Test & Trace (Part of Tier 1b of Track and Trace.)
Complex issues that cannot be resolved by the regional PHE Health protection teams
Outbreaks that need on the ground local responses
Supporting vulnerable people to isolate.
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Summary of Leads in our Outbreak Plan This programme will require co-ordination and leadership across a range of agencies. The leads for each workstream are stated here
Table 3: Programme and Workstream Leads
Priority Theme Lead Public Health Lead
Prevent and Respond
Prevention Hub
Louise Savory Consultant in Public Health, HCC Robin Trevillion, Health Protection Lead, HCC
Louise Savory Consultant in Public Health, HCC
Adult Care Services including Care Homes and Residential Settings
Tom Hennessy Asst Director, Adult Care Services, HCC
Joel Bonnet, Consultant in Public Health
Schools and Childrens’ Provision
Tania Rawle (Head of Standards, Schools)
Sue Matthews (Consultant in Public Health)
High Risk Settings (non-NHS) including workplaces
District Co-ordinator (to be confirmed)
Sue Matthews, Consultant of Public Health (Jo Capon, Public Health) Assisting
High Risk Setting (NHS) Jo Burlingham, NHS Tactical Co-Ordination Group Vice Chair
Miranda Sutters, Consultant in Public Health, HCC
NHS Primary Care Jo Burlingham, NHS Tactical Co-Ordination Group Vice Chair
Miranda Sutters, Consultant in Public Health, HCC
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Priority Theme Lead Public Health Lead
Lynn Dalton, Director of Primary Care, Herts Valleys CCG
Vulnerable People and Communities
Support to People Self-Isolating Taryn Pearson-Rose / Kristy Thakur Annette Sheer, Project Manager, Public Health
Systematic action on vulnerable people and communities
Robin Trevillion, Health Protection Lead, HCC
Louise Savory, Consultant in Public Health (linking to High Risk Setting)
BAME Communities HCC Staff Celeste Igolen-Robinson, Senior HR Manager, HCC NHS Staff Jane Halpin, Accountable Officer, CCGs Resident communities: Faizal Hakim, Equality and Diversity Manager, HCC
Zac Mather, Programme Manager, Public Health
Highways and Urban/Town Centre Safety
Rupert Thacker, Head of Highways Implementation and Strategy, HCC Bethan Clemence, Healthy Places Lead, Public Health, HCC
Bethan Clemence, Healthy Places Lead, Public Health
Personal Protective Equipment Brian Gale, Head of Commissioning, Public Health Louise Savory, Consultant in Public Health
Use of Enforcement Powers Nick Long, Director of Public Protection, Welwyn Hatfield Council
Duty Consultant in Public Health
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Priority Theme Lead Public Health Lead
Guy Pratt, Assistant Director, Community Protection, HCC
Deepti Kumar, Public Health England
Testing and Contact Tracing
Testing Co-ordination and Deployment
Miranda Sutters, consultant in Public Health
Contact Tracing Local capabilities
District Co-ordinator Linda Mercy, Consultant in Public Health
Co-ordination with Regional and National NHS Test and Trace
Ciceley Scarborough Public Health Lead, Public Health, HCC Deepti Kumar, Consultant in Communicable Disease Control, PHE East of England
Ciceley Scarborough Public Health Lead, Public Health, HCC
Surveillance, Intelligence and Data
Daily Surveillance Meeting Duty on Call Consultant in Public Health (daily) David Conrad, Consultant in Public Health, Evidence and Intelligence
Analytical, Forecasting and Modelling
David Conrad, Consultant in Public Health, HCC Will Yuill, Senior Analyst, Public Health
Information Sharing David Conrad, Consultant in Public Health, HCC Will Yuill, Senior Analyst, Public Health
Engaging Communities (see also vulnerable communities’ streams above and Elected Member Board below)
Communication Andrew Hadfield-Ames Head of Communications HCC
Joel Bonnet, Consultant in Public Health, HCC Joanne Necchi Communications Officer, HCC
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Priority Theme Lead Public Health Lead
Governance and Programme Co-ordination
Elected Member Engagement Board
David Williams, Leader, HCC Scott Crudgington, Director of Resources, HCC
Jim McManus, Director of Public Health Joanne Doggett, Head of Programmes, Public Health
Chief Executive Assurance Owen Mapley, CEO, Hertfordshire County Council Scott Crudgington, Director of Resources, HCC
Jim McManus, Director of Public Health Joanne Doggett, Head of Programmes, Public Health
Health Protection Board Jim McManus, Director of Public Health Darryl Keen (Co-Chair of SCG) Deputy Chair of this Board
Joanne Doggett, Head of Programmes, Public Health
Programme Management Office
Joanne Doggett, Head of Programmes, Public Health Katie Wallace, Programme Manager, Public Health
Internal Co-ordination Scott Crudgington, Director of Resources, HCC Joanne Doggett, Head of Programmes, Public Health
Katie Wallace, Programme Manager, Public Health
District Council and EHO Capacity into Programme Management Office
Joanne Doggett, Head of Programmes, Public Health Justine Hoy, Environmental Health, Welwyn Hatfield Council
Katie Wallace, Programme Manager, Public Health
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What we expect from every agency and stakeholder This plan will require multiple stakeholders working together. Everyone has a role to play. Below we identify the key roles to play. Table 4: Key expectations of each agency
Agency or Role Key Roles
Strategic Co-Ordinating Group
Exercise the Plan and test scenarios
Monitor levels of infection and be ready for a second wave through the Analytical Cell
Co-ordinate multi agency capabilities
Declare a Major Incident if and when agreed
The PPE Cell co-ordinates supply of Personal Protective Equipment
The Highways and Urban Safety Cell ensures public transport and High Streets are COVID-19 secure
The Testing and Swabbing Cell delivers, deploys and co-ordinates testing capabilities to prevent and manage outbreaks
Operation Sustain ensures people who are self-isolating get help with essential supplies to stay self-isolating
Escalation of issues to MHCLG and others as needed
Hertfordshire COVID-19 Member Engagement Board
Engage residents and oversee proactive and reactive communications
Sign off the Plan
Ensure each agency is able to play its part
Escalation of issues to government as needed
Hertfordshire COVID-19 Health Protection Board
Oversee the implementation and revision of the plan
Ensure partner agency representation and engagement
Ensure resource to Manage Outbreaks is in Place
Co-ordinate action across agencies
Ensure escalation where needed for SCG Capability deployment
Hertfordshire County Council
The Chief Executive leads assurance of the Plan and signs the Plan off
The Director of Resources supports the Member Board and ensures the grant is used to deliver the Outbreak Plan
Communications lead multi-agency proactive and reactive communications
The Director of Public Health and team o provides scientific and expert leadership, o programme management and capabilities o proactive and responsive advice and guidance on
outbreaks. o Provides Responsible Officer function for 1984 Act
for those districts appointing.
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o DPH signs delegations for enforcement of the 2020 regulations powers
o Provides epidemiology and surveillance capability and leads daily surveillance meeting
o Supports and Services Hertfordshire COVID-19 Health Protection Board
The Director of Community Protection provides officers who can take enforcement action and co-ordinates and supports the Local Resilience Forum
The Resilience Team operates the 24/7 call facility
The Adult Care Settings and Schools and Childrens Provision Workstreams prevent and manage outbreaks in these settings
The Equalities team and HR team lead on developing plans for BAME Communities
Every directorate should identify its links with vulnerable communities through provided and commissioned services and take requested action to support them in preventing infection and reducing risk from COVID-19.
Customer Services (Call Centre and Website) provide public facing direct contact capability
Care Providers and Herts Care Providers Association
Ensure care services (residential, domiciliary and supported living settings) are COVID-19 Secure
Ensure infection control processes in place compliant with HCPA and Care Home Cell and Public Health guidance
Schools, Colleges, University and other Educational Settings
Ensure the setting and its staff and students implement prevention measures and robust infection control practice
Ensure that the setting and its staff follow the pathway when a positive case or outbreak is reported
District and Borough Councils Still need to collate list of proper officers
Leaders of Districts participate in the Member Board and engage with communities directly and through the Board and Comms functions
Chief Executives ensure alignment of their capabilities to deliver required action to prevent and manage outbreaks
District and Borough Councils lead on creating maintaining registers of high-risk settings (other than schools and care homes) and take action to prevent and manage outbreaks in settings they have lead responsibility for.
District and Borough Councils lead on prevention and enforcement on workplaces (alongside the Health and Safety Executive) (excluding NHS, Police, County Council Settings and Social Care settings [residential or non-residential.]
District and Borough Councils lead on contact tracing in complex situations handed down from PHE/NHS Test and
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Trace where requested as agreed in the Memorandum of Understanding
District and Borough Councils lead on prevention and management of outbreaks in Houses of Multiple Occupation, Homeless and other hostels. EHOs will lead contact tracing and outbreak management for these settings.
Districts and Borough Councils ensure leisure facilities are COVID-19 secure in partnership with HSE
District and Borough Councils lead on enforcement powers under the 1984 and 2020 Acts and regulations (there is also a pool of County Council Officers designated to assist under the 2020 regs for enforcement [closures and fixed penalty notices.])
Agree a mutual aid agreement
Identify resource needed to undertake contact tracing and local outbreak management
District and Borough Councils agree between them resource to co-ordinate work. (Roles 2, 3 and 4 will be funded by Public Health. Other resource needed above will be met from the Outbreak Management Grant.)
1. Nominated leads to sit on the Health Protection Board
2. A lead District Co-ordinator who will liaise between Districts and Public Health and Programme Management Office
3. An officer to support mapping of high-risk settings 4. A central point of contact for response with the
surveillance cell to initiate action in Districts
NHS CCGs and NHSE/I as Commissioners
CCGS Ensure all commissioned providers are COVID-19 secure and have infection control plans in place which are robust
CCGs ensure infection control support to care settings (community or acute) is provided
CCGs ensure a senior lead to co-ordinate action is part of the Health Protection Board
A specific workstream to manage outbreaks in primary care
Management of outbreaks in NHS settings other than primary care through the Health Economy Tactical Co-ordinating Group
Use Population Health Management tools and techniques to identify cohorts of patients at heightened risk for a second wave, and take appropriate preventive actions
Ensure that primary care services are delivered in a safe way for COVID-19 (technology, hot and cold sites etc)
Assure all commissioned providers are using the IIMarch forms to capture actions taken to support outbreak management
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Feed information to NHSE/I and into Surveillance Cell on Outbreaks in NHS settings
Escalation of issues to NHSE/I and upwards as needed
NHS Provider Agencies
Every NHS Provider must have in place an infection control plan which prevents and manages outbreaks in their settings
Use Population Health Management tools and techniques to identify cohorts of patients at heightened risk for a second wave, and take appropriate preventive actions
Ensure that services are delivered in a safe way for COVID-19 (technology, hot and cold sites etc)
Ensure processes to reduce risk in admissions and discharges are done including elective procedures
o For elective procedures creation of risk reduction protocols including pre-admission measures
Provision of commissioned testing, swabbing and contact tracing
Responsibility to complete IIMarch forms and send to NHSE/I, Commissioner and Surveillance Cell
Public Health England (National)
National advice and guidance
Co-ordination of national programmes
Escalation of issues of national significance
National Surveillance and Intelligence
Test and Trace (National)
Operation of the national and regional test and trace system
Feed information to Hertfordshire through the analytical cell for epidemiology and surveillance
Reception of notifications of cases and contacts and management
Feed notifications and actions to Tiers 1a and 1b (PHE and Local) for action as needed
Public Health England (Regional)
Infection control advice to settings which have outbreaks
Risk assessment of settings which have outbreaks
Outbreak notification to Local Public Health and EHOs
Reception of notifications of outbreaks and cases from public and Test and Trace
Contact Tracing
Data Sharing
Operation of Memoranda of Understanding and outbreak management flowcharts
Provide proper officers for 1984 Act powers and 2020 Act and Regulations
Information and data feeds to Surveillance and Epidemiology function
Police Maintain Public Confidence and Order
Take such enforcement action as they deem necessary
Ensure their organisation is COVID-19 secure
Universities and Colleges
Ensure they operate within COVID-19 secure processes
Preventive advice and support to students and staff
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Early notification and response when cases are notified
Workplaces Ensure every workplace is COVID-19 secure
Ensure vulnerable workers are appropriately risk assessed
Proactively notify outbreaks and cases to test and trace/ Public Health England
Voluntary and Community Organisations
Support their communities in preventing and mitigating the impact of COVID-19 (e.g. homeless provision and care services ensure they have plans to prevent spread of infection.)
Ensure service provision is COVID-19 secure
Ensure vulnerable workers are appropriately risk assessed
Proactively notify outbreaks and cases to test and trace/ Public Health England
Entertainment Venues operate safely in line with best guidance
Follow COVID-19 secure guidance
Places of Worship operate safely in line with best guidance
Follow COVID-19 secure guidance
Transport Operators operate safely in line with best guidance
Follow COVID-19 secure guidance
Residents Continue measures to prevent themselves and others from COVID-19
Custodial Settings operate safely in line with best guidance
Follow COVID-19 secure guidance
Proactively notify outbreaks and cases to test and trace/ Public Health England
Work with NHSE/I to put in place pathways and processes to reduce risk
Homeless and Migrant residential and non-residential settings
operate safely in line with best guidance
Follow COVID-19 secure guidance
Proactively notify outbreaks and cases to test and trace/ Public Health England
Residential services (Homeless shelters, Temporary accommodation, Houses of multiple occupancy, authorised, unauthorised, private encampments, Gypsy and Traveller sites, Specialist refuge/safe accommodation and Women’s refuges);
Ensure they follow guidance on prevention and response
Ensure responsible authority includes them in their plans
Ensure they are included in assessment of high-risk areas
May need to consider targeted media campaigns
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Drop in services and other non-NHS care settings (Drug and alcohol/ substance misuse services, mental health and PLD, outreach support services and Soup kitchens);
Ensure they follow guidance on prevention and response
Ensure responsible authority includes them in their plans
Ensure they are included in assessment of high-risk areas
May need to consider targeted media campaigns
Supported living settings (non-NHS);
Ensure they follow guidance on prevention and response
Ensure responsible authority includes them in their plans
Ensure they are included in assessment of high-risk areas
May need to consider targeted media campaigns
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3. Priorities and Programmes Government have set seven Priorities for Local Outbreak Plans. At the same time, there are additional priorities from guidance or additional requests from government, or developing best practice. We have grouped these priorities together to form Five Programmes for the Hertfordshire Plan. These Programmes are mutually inter-dependent and the Board Table 5: Workstreams in Prevent and Respond Programme
Programme Government 7 Priorities
Additional Priorities
1. Prevent Outbreaks and Respond Proactively
Care Homes
Schools
Vulnerable People
High Risk Settings including workplaces
Prevention
Preparation for a possible Second Wave
Wider community care settings (all ages)
Workforce
2. Testing and Contact Tracing
Local Testing Capacity
Ensuring we enable the Test and Trace System to work effectively
Improving access to testing especially for high risk and vulnerable populations
3. Surveillance, Intelligence and Data
Data Integration
Epidemiological
Modelling
Escalation and monitoring dashboard easy to use by stakeholders
4. Engaging Communities
Member Engagement Board (Hertfordshire COVID-19 Member Engagement Board)
Communications
5. Governance and Programme Co-ordination
Member Engagement Board (Hertfordshire COVID-19 Member Engagement Board)
Health Protection Board (Hertfordshire COVID-19 Health Protection Board)
Programme Management Arrangements
Finance
Effective Delivery
Assurance and Evaluation
Links to LRF
Co-ordination of Capabilities
Workforce and Training
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4. Programme 1: Prevent and Respond This programme will co-ordinate existing and new arrangements to prevent the spread of COVID-19, and proactively manage outbreaks. While this programme is the largest programme within the Plan, it consists of a number of workstreams which have significant inter-relationships and grouping them together in one programme will enable workstreams to avoid duplication of effort. The programme will consist of the workstreams listed below. Each of these will have their own detailed work programme.
1. Prevention Hub - resourcing and enabling preventive activity and communication. This workstream will also be responsible for the forecasting and future casting of preventive and response action by monitoring when new technologies (e.g. the vaccine) will become available and ensuring the system puts in place arrangements to deliver these or make them available
2. Care Homes (Adult Care Services including Care Homes and Residential Settings) – ensuring outbreaks are prevented and managed in care homes
3. Schools and Childrens Provision – ensuring settings can operate safely and outbreaks are managed effectively 4. High Risk Settings (Non-NHS) – systematic identification and risk assessment of settings, and co-ordination of action 5. High Risk NHS Settings – because of the particular nature of NHS settings and risk of transmission, the NHS will have a dedicated
workstream on preventing and managing outbreaks in hospitals and NHS settings 6. Vulnerable People and Communities – systematic identification of populations at higher risk of getting COVID-19 or higher risk
of serious disease or outcomes if they do become infected; support to people self-isolating 7. Highways and Urban/Town Centre Safety – Ensuring town centres and businesses operate safely for residents 8. Enforcement Powers – ensuring we can use enforcement powers quickly, sensitively and appropriately
The key priorities of each Workstream are set out in the table below.
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Table 6: Priorities and Key Actions for Prevent and Respond Workstreams
Workstream Status Purpose of Workstream
Description, Priorities, Key Actions and Reporting
Lead
Prevention Hub
In place This workstream will be further developed to deliver future activities to be able to resource advice and support function to all workstreams
Enable workstreams to be effective by ensuring provision of technical, scientific and other resource needed for them
Provide a single source of advice and guidance on prevention and management of outbreaks
Identify gaps in preventive action and act to fill them as they arise
Provide rapid reactive support and advice as needed to settings
Where Workstream receives notifications from o Settings directly, Public Health England,
Workstreams, Stakeholder agencies
Key activities completed
Guidance to Schools, Care Homes
Guided development of the Care Homes Plan
Provided training to care workers and teachers
Safer business toolkit
Guidance to safer High Street
24/7 reactive advice and guidance service
Supported development of the Schools Plan
Advised Universities and Colleges on prevention of outbreaks
Advised Homeless settings on prevention of outbreaks
Guidance to community pharmacy on outbreak prevention
Guidance to workplaces
Supported
Behavioural science advice, guidance and design of campaigns and toolkits
Face coverings advice to residents
Guidance to faith communities and settings
Louise Savory, Consultant in Public Health
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Workstream Status Purpose of Workstream
Description, Priorities, Key Actions and Reporting
Lead
or workstream leads a
Key future activities
Advice and guidance to workplaces, settings and communities on preventing spread of COVID-19. In particular:
o Updates to guidance for care settings (June 2020)
o Updates to guidance for educational settings (July 2020)
o Collation of Action Cards for all settings from national and local sources (July 2020
Identify areas of prevention where action or resource is missing and ensure action is taken
Provision of technical and scientific support, advice and guidance - reactive and proactive
Use of behavioural Sciences to inform action
Development of tools and resources for other workstreams to use (e.g. Care Homes Guidance)
Maintain overview of all preventive action
Resource communications functions and advice on communications strategy to populations and settings
Develop prevention guides for any settings which don’t yet have them
Identify gaps in settings and areas where preventive action may need to be taken
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Workstream Status Purpose of Workstream
Description, Priorities, Key Actions and Reporting
Lead
Future-Proofing The Hub will also ensure that it identifies future technologies or interventions such as the availability of vaccines and identifies work needed to deliver these Where the Workstream reports to Through Health Protection Board to SCG
Care Homes (Adult Care Services
including Care Homes and Residential Settings)
In place Prevent and Manage Outbreaks in Care Homes and other adult care settings
To oversee, monitor and map outbreaks of Covid-19 across Hertfordshire. In doing so the Cell will share expertise and information amongst health and care professionals to support Care Homes and Care Home agencies to mitigate the impacts of outbreaks in order to support patient flow and to maintain homes and care services to remain open.
Where Workstream receives notifications from o CCG Outbreak Cells, from Homes directly and via
HCC monitoring officers.
Key activities completed
Care Home Plan in Place and signed off
Care Home Cell in place including programme delivery staff and monitoring team
Tom Hennessy Asst Director, Adult Care Services, HCC
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Workstream Status Purpose of Workstream
Description, Priorities, Key Actions and Reporting
Lead
COVID-19 response team in place in Herts Care Providers Association
PPE Supplies in Place
Hygiene, Workforce and PPE Guidance in Place
Systems to monitor and respond to symptomatic cases in place
Testing and swabbing systems for care home residents and staff in place
Actions for each of the Government’s high impact actions in place including Isolation and Step Down facilities for positive or symptomatic residents being discharged from Hospital
Key Future activities o Countywide surveillance and monitoring of Covid19
outbreaks in care homes, and any embargos etc. o Strategic oversight on the number of cases, number
of deaths and staffing levels across all the care homes across Hertfordshire
o Support care homes to continue to operate in order to manage and sustain capacity to deliver effective discharges from acute hospitals
o Support care homes to prevent admissions to the acute hospitals through enhanced medical support into the care homes
o Coordinate and expedite clinical advice and support around Infection Control to care homes and home care agencies
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Workstream Status Purpose of Workstream
Description, Priorities, Key Actions and Reporting
Lead
o Be a link with all the other operations hubs that are established, in particular with the Provider Hub
Where the workstream reports to o Through Health Protection Board to SCG
Schools (Schools and Childrens’ Provision)
In place Ensure Schools and Childrens’ Settings can operate safely
Ensure processes for testing, tracing and outbreak management are in place for schools
Preventing and minimising spread of COVID-19 in schools and children’s provision
Containing and suppressing outbreaks of COVID-19 in schools and children’s provision
Proactive and effective systems for communication, support and escalation in schools and children’s provision
Where workstream receives notifications from PHE, Test and Trace and directly from schools
Key Activities Completed Reactive advice and guidance rota of officers able to
support schools
Guidance to schools on safe management
Guidance to schools on managing infected or suspected infected students and staff
Incident Management System for schools with outbreaks
Communications support to schools
Tania Rawle (Head of Standards, Schools) and Sue Matthews (Consultant in Public Health) HCC
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Workstream Status Purpose of Workstream
Description, Priorities, Key Actions and Reporting
Lead
Key future activities Establish systems of support and guidance to
schools (PHE five principles – hygiene, small group numbers, avoid/reduce mixing, social distancing, enhanced cleaning) ready for new school year by July 2020
Establish systems that will provide assurance that schools and children’s provision are aware of, and are following national and local guidance by July 2020
Develop a pathway for schools and other children’s provision HCC with clear roles, responsibilities and timescales by July 2020
Ensure effective risk management and monitoring to identify areas for improvement and improve consistency across the county by July 2020
Effective early warning indicators through the use of surveillance data by July 2020
Promote effective two-way communication between HCC and schools and children’s provision and reassurance to relevant stakeholders (ongoing)
Where the workstream reports to Through Health Protection Board to SCG
High Risk Settings (non-
Plan in draft. Scenarios and
Systematic risk assessment of
Identifying and risk stratifying settings at high risk of spread of COVID-19
District Co-ordinator (to
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Workstream Status Purpose of Workstream
Description, Priorities, Key Actions and Reporting
Lead
NHS) including workplaces
responsibilities for different settings being worked through. Council by council risk assessment underway
places and settings at higher risk of COVID
Preventing and minimising spread of COVID-19 in high risk settings
Containing and suppressing outbreaks of COVID-19
Proactive and effective systems for communication, support and escalation
Where workstream receives notifications from PHE, Intelligence and Surveillance Cell, NHS Test
and Trace and directly from high risk settings
Key Activities
Systematically identify settings not already specified which are at heightened risk of transmission of COVID 19 including
o Workplaces o Houses of Multiple Occupation o Supported Living Settings o Places of Mass Gathering or High
Human Traffic o Further and Higher Education Settings
Risk assess and prioritise settings for preventive action
Contact settings identified proactively with advice and guidance including action cards for each setting
Ensure
be confirmed) Sue Matthews, Consultant in Public Health
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Workstream Status Purpose of Workstream
Description, Priorities, Key Actions and Reporting
Lead
Check that high risk settings have registers in place to enable contact tracing
Exercise incident response and management with highest risk settings
Identify highest risk settings for regular advice and monitoring
Where the Workstream Reports to Through the Health Protection Board to SCG and to the Recovery Tactical Co-Ordination Group (for workplaces.)
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High Risk NHS Settings and Primary Care Workstreams
Workstream priorities agreed with NHS. Infection control arrangements for secondary care in place. awaiting identification of Health Protection Board leads
Ensure COVID-19 transmission in NHS settings is prevented
Manage COVID-19 Outbreaks in NHS Settings
Key completed activities
Infection risk assessment for acute trusts
Infection control plans for COVID-19 in NHS settings including face masks, hygiene, PPE and physical distancing inside NHS settings
Directors of Infection Prevention and Control identified to lead for every NHS Provider Trust
Infection control plans in place in community pharmacy
Infection control plans in place in NHS Services commissioned by Public Health
“Hot” clinics in place in NHS Providers for people assumed to be COVID-19 infected
COVID-19 free facilities in place in every NHS Provider
Key Future activities
Systematically risk assess NHS settings for risk of transmission of COVID-19 between and among staff, visitors and patients
Identify a risk register of NHS settings at highest risk of outbreaks
Identify actions to be taken for each setting to reduce spread of the virus and a plan for each setting
Ensure every NHS Provider has taken infection and outbreak control plans through their Board
Ensure every GP Practice has infection control plan and an identified infection control lead adviser
Jo Burlingham, NHS Tactical Co-ordination Group Vice-Chair Lynn Dalton, Director of Primary Care, Herts Valleys CCG
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Identify processes for early management of Outbreaks
Ensure Protocols
Ensure each NHS Setting has a lead for COVID-19 infection control and prevention
Ensure seasonal ‘flu vaccination campaigns for NHS staff and vulnerable patients are in place (to reduce impact of ‘flu on services and reduce potential co-infection of vulnerable people.)
Where the Workstream Reports to Through Health Protection Board and NHS
Structures to SCG
Vulnerable People and Communities Substream: Support for people self-isolations
In place
Ensure people self-isolating are supported to stay self-isolating and can access food, medicine and essential supplies without breaking self-isolation
Key Activities a) Arrangements to ensure people self-isolating can
get essential food and medical supplies and not compromise isolation
b) Identifying communities most vulnerable to COVID and working with
c) Ensuring Primary Care identify, risk assess and take appropriate action to protect people identified at significantly increased risk of serious outcomes if infected
Where the Workstream Reports to Through the Health Protection Board to SCG
Taryn Pearson-Rose, HCC Kristy Thakur, HCC
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Vulnerable People and Communities Sub Workstream: Systematic action on vulnerable people and communities
Some activities completed Risk matrix in draft Identification of action cards for agencies underway
Identify
communities at increased risk of impacts from COVID-19 (infection, severe disease, mortality) and put in place preventive and mitigation measures
Key completed activities
Homeless settings have had advice, guidance and PPE supplies
Preventive guidance for people with learning disabilities rolled out
Public Mental health plan including resilience tools
Smoking cessation service for those vulnerable to COVID-19 who smoke rolled out, 500 people using service currently
Priority public health nursing service for families vulnerable to COVID-19 in place
Preventive testing of vulnerable adults and older people underway
Key activities underway
Co-morbidities and risk screening tool for primary care to identify people at heightened risk and take preventive action to include BAME patients (July 2020)
Identification of COVID-19 impact on shielding population and development of health improvement offer (muscle weakness recovery, strength loss recovery)
Key future activities
Identify vulnerability factors for COVID-19
Identify populations at heightened vulnerability and identify how
o Older people
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o Shielding populations o People with learning disabilities o People with severe mental illness o Populations of identity (travellers,
migrant workers) o BAME Populations (identified below as
a separate workstream) o People with co-morbidities
Establish leads in agencies for each population and
Agree action cards for each vulnerable population and agencies working with them
Commissioners to assure that enhanced seasonal vaccination campaigns (‘flu, Meningitis, pneumococcal, etc) are in place (to reduce impact on services and reduce potential co-infection of vulnerable people.)
Seek assurance that immunisation services are in place and prioritising vulnerable people.
Where the Workstream Reports to Through the Health Protection Board to SCG
Vulnerable People and Communities Sub-Workstream: BAME Populations
In development (Some activities in place already)
Identify actions which can
Key activities completed
COVID-19 advice and guidance (video and print) made available in community languages
BAME communities linked into PHE Review and inquiry
Rapid review of risk of BAME populations (superseded by PHE Review) and action plan group convened by Recovery Cell
HCC Staff Celeste Igolen-Robinson, Senior HR Manager, HCC NHS Staff
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Smoking Cessation service increased for BAME populations to reduce risk if COVID contracted
Key activities underway
Co-morbidities screening tool for primary care including BAME communities
Infection control advice and guidance for BAME taxi drivers
Key future activities
Risk assess BAME Staff and ensure preventive measures and actions are in place, prioritising social care (all ages) and NHS staff
Identify high risk BAME workforces outside
Identify BAME led small and medium enterprises for preventive advice and support
Co-produce assessment of impact with BAME communities and action plan
Ensure that seasonal ‘flu and pneumococcal vaccination campaigns target BAME populations most vulnerable to infection
Where the Workstream Reports to Through the Health Protection Board to SCG
Jane Halpin, Accountable Officer, CCGs Resident communities: Faizal Hakim, Equality and Diversity Manager, HCC
Highways and Urban/ Town Centre Safety
In Place Ensuring measures are in place to enable social distancing and preventive actions in High streets,
Structure Convened of key Highways personnel, including District Leads and Communications officer Key activities completed
Safer high streets programme rolled out
Rupert Thacker, Head of Highways Implementation and Strategy, HCC and Bethan
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Roads and Transport settings
Safer Public Transport advice to transport operators rolled out
Public campaigns for each of these rolled out
Key future activities
To review and best practice measures of road space in busy public spaces in light of 4 July 2020 measures (July 2020)
Review and redraw plans for each Districts on parking and roads. (July 2020)
Empower & engage with Districts to help maintain the traffic management (ongoing)
Monitoring road network as the use of public transport (ongoing)
communicate with residents, businesses and Members and other users (ongoing.)
Where the workstream reports to Recovery Tactical Group
Clemence, Healthy Places Lead, Public Health, HCC
PPE
In Place Co-ordination of essential PPE supplies for high risk settings such as care homes
Key completed activities Assessed current and projected availability of
PPE and any issues with supply
Co-ordinate arrangements for requesting and distributing PPE stock provided by central government
Procured emergency PPE supplies on ongoing basis
Brian Gale, Head of Commissioning, Public Health, HCC
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Enabled all organisations to access appropriate PPE
PPE guidance and training for all care and educational settings
communications specifically relating to PPE for the system
advice and guidance on disposal of PPE
Procure and maintain resilience stock of PPE
Key future activities
Continue with action above (ongoing)
Ensure any new and emerging guidance relating to PPE is communicated to the system, working with the Prevention Hub (ongoing)
Consider strategic/tactical issues relating to PPE and escalate accordingly (ongoing)
How this Workstream Reports SCG
Enforcement Powers Sub-workstream Coronavirus (Restrictions) 2020 regulations
In place
Ensuring 2020 Act enforcement powers can be used appropriately, sensitively and quickly
Key completed activities
Agreement between all eleven council on use of 2020 regulations
Ensured sufficient personnel in District and County Council to enforce the 2020 regulations
Establish, in liaison with legal services a register of suitably trained and accredited officers who can issue enforcement notices and take enforcement action
Maintain records of enforcement actions
Nick Long, Director of Public Protection, Welwyn Hatfield Council Guy Pratt, Assistant Director,
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Key future activities
Provide reactive function to enforce regulations including premises closure (ongoing)
Ensuring rapid access to Designated Officers for the purpose of the Act at local level
Districts to amend constitutions to appoint additional local designated officers for the 1984 act
How this workstream reports From the Herts EHO/Trading Standards Liaison Group to the Health Protection Board to the Recovery Tactical Co-ordination Group
Community Protection, HCC
Enforcement Powers Sub- workstream
Shared approach to Public Health (Control of Diseases) Act
In development
Ensure 1984 Act powers can be used effectively
Key activities underway
Legal Services HCC (Luis Andrade, Principal Solicitor HCC) developing legal toolkit
Key future activities (end July2020)
Develop shared protocols to ensure the provisions in the 1984 Act and 2010 Regulations can be used effectively and swiftly
Developing a shared protocol to use of the provisions in the Act for isolation, quarantine and any associated actions and procedures (e.g. orders not to attend school)
Developing shared template tools and resources
Nick Long, Director of Public Protection, Welwyn Hatfield Council
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1984 Act and its regulations
Ensuring rapid access to Designated Officers for the purpose of the Act at local level
Districts to amend constitutions to appoint additional local designated officers for the 1984 act
How this workstream reports From the Herts EHO/Trading Standards Liaison Group to the Health Protection Board to the Recovery Tactical Co-ordination Group
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5. Programme Two: Testing and Contact Tracing Rapid and easily accessible testing is key to any pandemic management in order to establish and monitor levels of infection and immunity in the system, plan for service demand, prevent asymptomatic spread of infection to vulnerable cohorts, identify who needs treatment and care, and keep the workforce and services resilient. This programme will focus on ensuring that Testing Capability, Contact Tracing and Associated Action is delivered, through the following workstreams:
1. Testing Co-ordination and Deployment: The Development of local testing capabilities (including mobile reactive testing for outbreaks) to support the objectives of the Plan
2. Contact Tracing Local Capabilities: Complementing the national test and trace system through the development of local contact tracing capabilities, with an interim system in place from 1st July while a more permanent system is stood up.
3. Co-ordination: Working with Public Health England and all other partners on an East of England basis to ensure consistent pathways between National, Regional and Local Aspects of the NHS Track and Trace System.
This programme will co-ordinate existing and new arrangements to prevent the spread of COVID-19, and proactively manage outbreaks. While this programme is the largest programme within the Plan, it consists of a number of workstreams which have significant inter-relationships and grouping them together in one programme will enable workstreams to avoid duplication of effort. A Detailed strategy for testing has been developed. A new regional testing site and mobile testing unit have already been secured as part of this work.
National and Local Roles The aims of the national test and trace service are to reduce the national R number to below 1.0; save lives; and allow safe release from lockdown. The national capacity around contact tracing consists of teams of national call handlers (Level 3) and professional contact tracers employed via NHS Professionals (Level 2). More complex issues will be passed to local areas (Level 1).
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The key roles and responsibilities of the national test and trace service (Tiers 2 and 3) are as follows:
Providing advice to contacts according to Standard Operation Procedures (SOPs) and scripts. This will include the Household and Community contexts of cases escalated to Tiers 1a and 1b.
Tier 3 call handlers to escalate difficult issues to the Tier 2 staff who will deal with these issues.
The interviewing of cases, and identifying their contacts using Standard Operating Procedures (SOPs) and scripts
Tier 2 staff will escalate complex issues and situations to Tiers 1a and1b (Regional and Local).
As part of the test and trace service, cases where there is added complexity, high risk setting, or people who are more vulnerable will be passed to local areas to provide more bespoke support (Tiers 1a and 1b). To enable this in Hertfordshire, the existing contact tracing capacity is insufficient. A new contact tracing capability will be stood up which will create a team who will support individual workstreams and the health protection board carry out contact tracing in complex settings as part of the outbreak management. The Table below sets the workstreams out in more detail.
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Table 7: Priorities and Key Actions for Testing and Contact Tracing Workstreams
Workstream Status Purpose of Workstream
Description, Priorities and Reporting Lead
Testing Co-ordination and Deployment
In Place Ensuring testing capability supports deliver of Outbreak Plan priorities and is easily deployable
Key completed activities Mobile Testing Unit in place to be deployed to
schools, workplaces and other settings
Swabbing service for care homes and schools in place commissioned by Public Health from Herts Urgent Care
Pathway for symptomatic residents and staff in care homes in place
New regional test centre in Welwyn Garden City
Testing sites in Wembley, Stansted, Stevenage, Hertford and Hemel Hempstead accessible for staff and keyworkers
Transport for people who cannot travel to testing unless they use public transport
Testing provision for outbreak management in any setting (e.g. school and care home outbreaks)
Training staff in care homes to Swab
Preventive swabbing and testing
Key activities underway
Commissioning of additional testing capacity from Herts Urgent Care by Public Health. Go live date 1st July
Key Activities
Miranda Sutters, Consultant in Public Health, HCC
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Workstream Status Purpose of Workstream
Description, Priorities and Reporting Lead
Identify additional capacity needed to enable every setting to have access to testing (July 2020)
Commission asymptomatic pathway and testing services for Care Homes (July 2020)
Liaise with Military, NHS and Others to ensure testing capacity from military and regional units is maintained (ongoing)
Ensure a transfer of care testing pathway is in place (July 2020)
Extend the capacity of the mobile military testing units as required (ongoing)
Work in collaboration with national and regional teams on test and trace to continually assess/amend the pathways in place to enable the testing of all symptomatic individuals (ongoing)
Coordinate the local approach to antibody testing (by October 2020)
Where the Workstream Reports to Through the Health Protection Board to SCG
Contact Tracing Local Capabilities
Interim Contact Tracing Surge Capacity goes
Ensure Contact
Tracing locally can support the
Key activities underway Interim contact tracing solution commissioned
from Herts Urgent Care will go live on 1st July 2020 while PHE and National systems identify roles for local contact tracers. This will be in
Linda Mercy, Consultant in Public Health, HCC
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Workstream Status Purpose of Workstream
Description, Priorities and Reporting Lead
live on 1st July 2020
National Test and Trace Programme
addition to existing “business as usual” capacity in Environmental Health Depts.
Key future activities Identify local elements of Contact Tracing in
partnership with PHE (July 2020)
Referral routes for local contact tracing are likely to come from high risk settings. Codify pathways of what stays with PHE and what comes to us (July 2020)
Put in place arrangements and capacity for local contact tracing (July 2020)
Liaise with Vulnerable Peoples workstreams to ensure support for people isolating (underway)
Liaise with Enforcement Workstream to ensure enforcement powers can be used appropriately if needed (underway)
Receipt of escalated cases from Level 2 and 3 of the national Test and Trace service and from PHE East of England (not yet confirmed by PHE)
Receipt of contact tracing requirements directly from workstreams where local intelligence identifies issues in the first instance (July 2020)
Completion of setting-specific contact tracing or escalation to appropriate setting to undertake contact tracing themselves (e.g. hospitals; fire & rescue service; police) (July 2020)
Information sharing (June 2020)
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Workstream Status Purpose of Workstream
Description, Priorities and Reporting Lead
Escalation protocol for potential individual / household support requirements (June 2020)
Where the Workstream Reports to Through the Health Protection Board to SCG
Co-ordination with National and Regional Functions
In Place Ensure that there is clear co-ordination and understanding of responsibilities from National to Local for Testing and Contact Tracing
Key Activities underway Develop standard operating procedures and
agree these (July 2020)
Develop shared action cards (July 2020)
Develop information and communication flows from National to Regional to Local (July 2020)
Develop information sharing pathways and systems for patient identifiable contact data (June 2020)
Where the Workstream Reports to Public Health England/ADPH Regional Hub
Ciceley Scarborough Public Health Lead, Public Health, HCC Deepti Kumar, Consultant in Communicable Disease Control, PHE East of England
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6. Programme Three: Surveillance, Intelligence and Data This programme will ensure the Board is provided with good intelligence and data. Monitoring and forecasting the spread of disease in Hertfordshire is crucial to enabling effective action, as well as providing other workstreams with information they need to deliver their functions. The programme will consist of the workstreams listed below. Each of these will have their own detailed work programme.
1. Daily Surveillance Meeting - daily monitoring, as in any ongoing outbreak, and identification of actions and information flows to workstreams 2. Analytical, Forecasting and Modelling – Analysing data and providing modelling and intelligence reports to enable action 3. Information Sharing – Ensuring information sharing can be undertaken proactively and effectively
Data flows will be crucial to enabling this workstream. These are outlined in the figure below and the key priorities of each Workstream are set out in the table below.
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Figure 3: Data Flows for Outbreak Management
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Table 8: Priorities and Key Actions for Surveillance and Data Workstreams
Workstream Status Purpose of Workstream
Description, Priorities and Reporting Lead
Daily Surveillance Meeting
Reactive on call rota in Place New daily surveillance meeting to stand up from July 2020
To provide rapid intelligence on existing and emerging outbreaks and identify action to be taken
Key completed activities 24/7 on call public health consultant rota in
place
Epidemiological dashboard first version developed
Key future activities
Finalise new surveillance dashboard (July 2020)
Review information from various sources on a daily basis
Identify any alerts and actions and information flows arising from this
Consider whether Outbreaks can be met within existing resources or need additional action
Where the Workstream reports to Health Protection Board
Duty on-call Public Health Lead to convene each day
Analytical, Forecasting and Modelling
In Place Provision of Epidemiological Intelligence and Modelling
Key completed activities Regular epidemiological surveillance reports to
SCG and stakeholders on infection levels and service demand
Regular modelling reports for decision making (including R numbers, modelling of interventions and forecasting infection levels)
David Conrad, Consultant in Public Health, HCC
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Workstream Status Purpose of Workstream
Description, Priorities and Reporting Lead
Response escalation dashboard first version in place
Key future activities
Provision of regular reports on existing outbreaks and situations including standard epidemiological indicators on burden of disease, death and infection
Modelling of existing and likely Rt and other epidemiological indicators against interventions being taken or planned
Modelling of NHS and other service capacity needed on an ongoing basis
Modelling of future waves of infection
Monitoring and forecasting the spread of the disease in Hertfordshire using secondary data
Informing other work streams with ongoing estimates of how rapidly the disease will spread
Informing other work streams of the outcomes and implications of the wider epidemiology and modelling work fed into the SCG
Identify currently available data sources
Identify initial reporting needs
Develop daily reporting processes
Establish processes for informing workstreams of virus spread/ demand modelling and forecasting outputs
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Workstream Status Purpose of Workstream
Description, Priorities and Reporting Lead
Where the Workstream reports to Through Health Protection Board to SCG (Some work reports directly into SCG)
Information Sharing
Data sharing agreement signed between HCC and PHE. Data flow processes established.
To ensure information sharing is effective
Key activities underway Data sharing protocol for postcode level data in
draft
Key future activities
Agreement of information sharing protocols and information governance tools
Ensuring access to key systems for transfer and sharing of data and reports to enable action
Ensuring standardisation of reporting information to enable analysis
Ensuring primary Secondary data flows in from all relevant sources, including PHE, NHSE and other parts of the local health and care system
Where the Workstream reports to Through Health Protection Board to SCG (Some work reports directly into SCG)
David Conrad, Consultant in Public Health, HCC
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7. Programme Four: Engaging Communities Effective communication with local communities is essential in managing outbreaks and for this reason E This programme will co-ordinate existing and new arrangements to prevent the spread of COVID-19, and proactively manage outbreaks. While this programme is the largest programme within the Plan, it consists of a number of workstreams which have significant inter-relationships and grouping them together in one programme will enable workstreams to avoid duplication of effort.
1. Hertfordshire COVID-19 Elected Member Engagement Board – this Board will be key in ensuring elected members can communicate across the County, and within Districts/Boroughs and localities.
2. Communications Cell – A dedicated communications cell which co-ordinates communication capabilities across Hertfordshire partner agencies.
While the Communications Cell will liaise with multiple workstreams from other programmes, a number of workstreams will play key ongoing supportive roles in enabling communication and engagement:
Prevention Hub - The behavioural sciences and advice functions of the Prevention Hub enable messaging and create resourcing to be used in communications
Surveillance and Analytical Programme – This workstream’s outputs will enable Communications and the Member Board
Governance and Programme Co-ordination – will ensure communications and the Member Board is effectively resourced
The key priorities of the Communications Workstream are set out below. The key priorities of the Hertfordshire COVID-19 Member Engagement Board are set out in Programme Five: Governance and Programme Co-ordination
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Table 9: Priorities and Key Actions for Communications Workstream
Workstream Status Purpose of Workstream
Description, Priorities and Reporting Lead
Communications
In place but further additional resourcing has been identified
Engage the public in
Maintain public trust in measures to prevent and control outbreaks
Key activities completed Consistent, clear public messaging, aligned
at national and local level
Regular and repeated campaigns on preventive measures and actions
Key ongoing activities
Develop targeted and general campaigns to support prevention and outbreak management as identified by other cells (ongoing)
To provide accurate and timely information throughout the course of the pandemic to the public
Ensure that health and social care staff have the right information at the right time to perform their role and enable them to respond to enquiries from the public
Key future activities
Ensure elected member board has dedicated communications capability (July 2020)
Public facing version of plan launched and communicated (June 2020)
Andrew Hadfield-Ames, Head of Communications, HCC
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Establish and maintain confidence in the ability of Hertfordshire services to prepare and manage an effective response
Identifying future communications capacity needs for workstreams
Where the Workstream reports to Hertfordshire COVID-19 Elected Member Engagement Board and SCG
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8. Programme Five: Governance and Programme Co-Ordination This programme will consist of the arrangements to ensure the Plan is well co-ordinated and governed. The arrangements in brief are:
Hertfordshire COVID-19 Elected Member Engagement Board – This board will be convened by the Leader of the County Council, has met in shadow form and will provide assurance to the public as well as ensuring all eleven councils work together. This Board will sign off the Plan.
Hertfordshire COVID-19 Health Protection Board – This Board will lead on actions to co-ordinate and deliver actions to prevent and manage Outbreaks of COVD-19 in Hertfordshire. It will be multi-agency and will use both existing and new structures and systems. This Board will own, deliver and develop the Plan.
Programme Management Office – A dedicated team of programme management capabilities which will ensure delivery of the Board’s objectives
Internal Hertfordshire County Council – Reporting and Co-ordinating, Assurance Finance. The County Council will lead on this since the
grant for Outbreak Management has come to the County Council. Each programme will develop detailed plans and financial proposals.
The Health Protection Board will be a Cell of the Strategic Co-ordinating Group of the Local Resilience Forum. There will also be reporting into the PHE Regional Hub and through there to the Joint Biosecurity Centre and NHS Track and Trace The Chief Executive of Hertfordshire County Council, whose role among others is to sign off the plan, will attend as he needs to either or both of the Member Board or the Health Protection Board ex-officio. These are set out graphically in more detail below, and the priorities for each aspect of this, along with terms of Reference, are also provided in Appendices.
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Figure 4: Reporting and Governance Arrangements
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Table 10: Priorities and Key Actions for Governance and Programme Co-Ordination Workstreams
Workstream Status Purpose of Workstream
Description, Priorities and Reporting Lead
Hertfordshire COVID-19 Elected Member Engagement Board
Structure and terms of reference agreed, Shadow meetings already taken place
To provide assurance to the Public and Oversight of the Plan
Key completed actions Agreement from all Herts Council Leaders and
Police and Crime Commissioner to constitute Board
Initial discussion of outline plan approved
Terms of reference approved
Cycle of meetings agreed
Key future actions
To provide oversight of the Plan and Health Protection Officer Board
To lead engagement with the Public
To provide assurance to the public
To publish public facing version of plan
To ensure alignment across organisations especially Councils of actions needed
David Williams, Leader of Herts County Council Scott Crudgington, Director of Resources, HCC leads on liaison with District CEOs and support to Leaders Board
Chief Executive Assurance
Meetings underway
To ensure the Chief Executive of HCC is assured the plan and arrangements are robust and effective
Key activities underway Regular meetings to discuss and agree draft
CEO ability to attend Boards as needed written into arrangements
Key future activities Regular assurance meetings
Owen Mapley, CEO, Hertfordshire County Council
Hertfordshire COVID-19
Terms of reference agreed, first
To deliver, update and manage the Outbreak Plan and
Key completed Activities Terms of reference agreed
District Lead CEO agreed
Jim McManus, Director of Public Health
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Workstream Status Purpose of Workstream
Description, Priorities and Reporting Lead
Health Protection Board
shadow meeting taken place
associated capabilities
Officers from all agencies except NHS nominated
Key activities underway
Developing the Outbreak Plan and workstream plans underneath it
Key future activities
To co-ordinate agencies and capabilities directly and through the Strategic Co-ordinating Group of the SCG
To oversee and manage programmes and activities to prevent and manage spread of COVID-19
Identification of actions to prevent and manage outbreaks (the plan)
Oversight and facilitates progress of the project.
Acts as an escalation point for unresolved issues from the Project Team
Calls upon workstream leads and other agencies as required
Where this workstream reports The Strategic Co-Ordinating Group
Darryl Keen (Co-Chair of SCG) Deputy Chair of this Board
Programme Management Office
In Place To resource the Board and Plan and ensure it delivers
Key Activities completed Programme management leads in place
Programme Initiation document in place
Programme leads for all workstreams
Joanne Doggett, Head of Programmes,
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Workstream Status Purpose of Workstream
Description, Priorities and Reporting Lead
Arrangements for convening
Key future activities
To apply programme management approaches to ensure the Plan and Board are effective
To ensure programme management and deliver capabilities are provided
Agree the scope and outputs to be delivered from each workstream.
Develop the project plan, including identifying dependencies between work streams.
Identify any high-level issues/ risks that threaten the success of the project and bring these to the attention of the Cell Board.
Update issues/risks logs ensuring each issue/risk is assigned an owner and is managed in accordance with HCC’s risk management strategy
Monitor the progress of each work strand against the plan and report progress to the Cell Board.
Ensure that all appropriate project management documentation is produced.
Lead on ensuring workforce issues are addressed (capabilities, capacity and training) in liaison with workstream leads.
Where this workstream reports
Public Health, HCC
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Workstream Status Purpose of Workstream
Description, Priorities and Reporting Lead
Health Protection Board
Internal Co-ordination
In Pl ace Support the Boards by ensuring appropriate internal reporting
Key Activities Ensure the Member Board is resourced and
convened
Ensure liaison with Herts Chief Executives and Recovery Co-ordinating Group
Ensure Financial Bids and Business cases managed
Ensure internal reporting within Herts County Council and reporting on use of Grant to government
Where this Workstream Reports to Health Protection Board, SMB
Scott Crudgington, Director of Resources, HCC Joanne Doggett, Head of Programmes, Public Health, HCC
Finance In development
Ensure process in place to manage grant allocation
Key actions underway Scheme for business cases for funding to be
developed
Criteria for eligible expenditure to be developed
Process for agreeing expenditure to be developed
Jackie Albery, Head of Finance, HCC
District Council and EHO Capacity into Programme Management Office
In development
A dedicated resource to support co-ordination across ten districts and liaise with Programme
Key actions completed Role description written
Funding identified from Public Health
Five Officer Representatives have been nominated to be on the Board who will represent between them the ten districts and boroughs
Joanne Doggett, Head of Programmes, HCC and Justine Hoy, Environmenta
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Workstream Status Purpose of Workstream
Description, Priorities and Reporting Lead
Management Officer
Key actions underway
Identification of staff resource
l Health, Welwyn Hatfield Council
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Appendix 1: Member Engagement Board Terms of Reference
Hertfordshire Covid 19 Member Engagement Board
Terms of Reference
Version 1.2 30th June 2020 (approved by Shadow Member Board)
Purpose
1.1 The purpose of the Hertfordshire COVID-19 Health Member Engagement Board is to engage with residents and communities
1.2 The Board shall in furtherance of this:
i. Endorse the Local Outbreak Plan
ii. Identify and agree priorities for public engagement
iii. Work together across agencies to ensure that leadership and capabilities needed by the Health Protection Board or workstreams are in place
iv. Identify and keep under review actions for Leaders of Councils and the Police and Crime Commissioner to support the delivery of the Local Outbreak Plan
v. Develop a communications programme in support of this
vi. Review the Local Outbreak Plan and performance against it
Chair
The Board shall be chaired by the Leader of Hertfordshire County Council who shall nominate
Elected Members The Leader of Hertfordshire County Council
The Executive Member for Public Health and Prevention, Hertfordshire County Council
The Leaders of District and Borough Councils in Hertfordshire or their nominated Deputies
The Police and Crime Commissioner or his nominated Deputy
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CCGs /ICS Chair or Accountable Officer of the ICS
Officers in Attendance Owen Mapley, Chief Executive, Hertfordshire County Council and/or
Scott Crudgington, Director of Resources, Hertfordshire County Council
Jim McManus, Director of Public Health, Hertfordshire County Council
Jeff Stack, CEO, Broxbourne Borough Council
Darryl Keen, LRF and COVID SCG Chair
Nick Long, Recovery TCG and Welwyn Hatfield Council
Others Others called or invited as needed
Substitutes
Each Member may nominate a substitute if they are unable to attend a meeting. The Deputy Chair will be a standing substitute for the Chair when unable to attend.
Secretariat
The Members Services Team at Hertfordshire County Council will provide the secretariat
Quorum
The Board shall be Quorate if at least half the Members are present including the Chair and/or Deputy Chair
Meetings
Meetings may be held with such frequency as are required.
Review
Date of last review: 30th June 2020
Version: 1.2
The TOR will be reviewed three months after coming into effect
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Appendix 2: Health Protection Board Terms of Reference
Hertfordshire Covid 19 Health Protection Board Terms of Reference
Version 1.3 30th June 2020
Purpose
1.1 The purpose of the Hertfordshire COVID-19 Health Protection Board is to protect the health of the population of Hertfordshire by preventing and responding to Outbreaks of COVID-19.
1.2 The Board shall in furtherance of this:
vii. Act as a Cell of the Strategic Co-ordinating Group of the LRF
viii. Produce and co-ordinate the delivery of a Local Outbreak Plan
ix. Identify and keep under review actions to both prevent and manage outbreaks of COVID-19, having regard to both the patterns and distribution of infection in Hertfordshire, best current evidence on what is effective in preventing and managing outbreaks, and organisational and system capabilities
x. To set up standing arrangements for co-ordination and delivery of actions (e.g. Cells or Teams for specific settings or sectors such as Care Homes, Schools and so on)
xi. Liaise with relevant agencies locally, regionally and nationally including the National Biosecurity Centre, Public Health England and others
xii. Agree Standard Operating Procedures for Outbreaks including consistent approaches for managing and using enforcement powers where they are needed
xiii. Agree data sharing arrangements for data and intelligence sharing
xiv. Establish an Epidemiological and Analytical function which will
a. Review data and evidence to make recommendations on actions to tackle the coronavirus.
b. Maintain a daily review of evidence and intelligence to inform proactive and reactive action
xv. Maintain a Programme Management Office which will
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a. Co-ordinate actions and workstreams and ensure effective resourcing
b. Prepare assurance and other key governance reports
xvi. Ensure On-Call arrangements are in place and effective
xvii. Provide Assurance to elected Members, Chief Executives and national bodies as required
xviii. Support the Member-Led Engagement Board in communicating with and assuring local communities
Chair
The Board shall be chaired by the Director of Public Health
The Chair of SCG and a Public Health England Consultant in Communicable Disease Control shall be Deputy Chairs
Membership
Hertfordshire County Council The Chief Executive of the County Council may attend such meetings as he deems necessary
Standing Members Ad Hoc Members (invited for specific meetings or
topics)
Director of Public Health Health Protection Lead Consultant in PH Evidence and Intelligence Resilience Tea
Duty Consultant in Public Health Community Protection (Enforcement) Adult and Community Services Children and Young Peoples Services
Strategic Co-ordinating Group Darryl Keen, Co-Chair (or nominated deputy.)
CCGs Jo Burlingham, Health Economy Tactical Co-ordinating Group Vice-Chair,
East and North Herts CCG
District and Boroughs The Chief Executives’ Co-ordinating Group will be represented by Jeff Stack, Chief Executive, Broxbourne Borough Council
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Nick Long, Director of Public Protection, Welwyn Hatfield Council, will represent the Recovery Tactical Co-ordinating Group and is also District and Borough Lead for the Strategic Co-ordinating Group of the LRF District and Borough Councils between them agreed the nomination of five officers to sit on this Board, representing the ten Districts and Boroughs
District/Borough Pairing Officer
Broxbourne and Stevenage Rebecca Broadbelt– [email protected]
East Herts and North Herts Paul Thomas-Jones – [email protected]
Watford and Three Rivers Justine Hoy – [email protected]
Dacorum and St Albans Emma Walker - [email protected]
Welwyn Hatfield and Hertsmere Jo Harding - [email protected]
Public Health England Consultant in Communicable Disease Control
Police Superintendent Mike Todd
Substitutes
Each Member may nominate a substitute if they are unable to attend a meeting. The Deputy Chair will be a standing substitute for the Chair when unable to attend.
In Attendance
Workstream Leads, Programme Management Team and NHS Test and Trace programme leads as required, and such others as the Board shall determine.
Secretariat
The Programme Management Office will provide the Secretariat
Quorum
The Board shall be Quorate if at least one member from each sector listed above are present including the Chair and/or Deputy Chair
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Meetings
Meetings may be held with such frequency as are required.
Review
Date of last review: 23rd June 2020
Version: 1.2
The TOR will be reviewed three months after coming into effect
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Appendix 3: Legal Powers to enforce actions required in managing Outbreaks Legal Powers for Local Closures
No general power to require people to stay apart or at home
No general power to close things as a precaution – need to prove that they are a problem
No powers which applies to everything – need to use miscellaneous powers.
Legislation Setting What it does Enforcing Authority Legal issues Timescale to implement
Health Protection (Coronavirus, Restrictions) Regulations 2020 (as amended)
General Closure of premises, dispersal of gatherings, issue of fixed penalty notices for contravention Authority can designate “Relevant persons” for the purposes of Regulation 8 with authority to issue prohibition notices in respect of contraventions of Regulations 4 or 5 of the Regulations (Closing premises) Authority can designate “Authorised and Relevant persons” for the purposes of Regulations 8 and 10 of
Both County and District Councils Each District Council has designated a list of relevant and authorised persons. The Director of Public Health for the County Council has designated a list of relevant and authorised persons
Requires appropriately trained person All councils have designated a list of officers who can use these powers
Immediate
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Legislation Setting What it does Enforcing Authority Legal issues Timescale to implement
the Regulations with authority to issue prohibition notices and fixed penalty notices in respect of contraventions of Regulations 4 or 5 of the Regulations (closing premises)
Public Health (Control of Disease) Act 1984 Section 45G
General People: Allows magistrate to make an order to force a person to quarantine, stay off work etc, we if they are or may be contaminated for up to 28 days
District Council / Unitary Council Requires Magistrates Approval
Extensive evidence requirements, including a medical report on the person(s) concerned Order can only last 28 days
Days
Public Health (Control of Disease) Act 1984 Section 45H
General Things: Allows magistrate to order seizure or detention or isolation or destruction of property
District Council / Unitary Council Requires Magistrates Approval
Requirement to notify owner/person with custody
Days
Public Health (Control of Disease) Act 1984 Section 45I
General Places: Allows magistrate to make order requiring infected premises to be closed or cleaned or destroyed
District Council / Unitary Council Requires Magistrates Approval
Requirement to notify owner or occupier Requirement for
Days
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Legislation Setting What it does Enforcing Authority Legal issues Timescale to implement
premises to be contaminated (rather than occupied by infected persons)
Public Health (Control of Disease) Act 1984 Section 45J
General Allows Magistrate to make a group order (i.e. one of the above orders with respect to a group of people, things or places)
District Council / Unitary Council Requires Magistrates Approval
Evidential requirements still apply in same way as to individual order
Days
Environmental Protection Act 1990 Section 79
General Allows abatement notice to be served requiring remedial action if premises are prejudicial to health or a nuisance
District Council / Unitary Council
Appeal to magistrates court
Days
Health Protection (Local Authority Powers) Regulations 2010/657 Regulation 8
General People; allows the service on individual or groups requesting that they do not do things to spread infection.
District Council / Unitary Council
No power to compel (see s45G 1984 Act
Immediate
Section 35 Antisocial Behaviour Policing and Crime Act 2014
General Allows police to disperse people if crime or disorder
Police Immediate and Lasts 48 hours Need to say that there is crime or disorder
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Legislation Setting What it does Enforcing Authority Legal issues Timescale to implement
Section 43 Antisocial Behaviour Policing and Crime Act 2014
General Community Protection notice. Notice can be served on individual or body if their conduct is having a detrimental effect of a persistent or continuing nature on the quality of life of those in the locality and the conduct is unreasonable
Police or District Council / Unitary Council
Need to give prior warning. Appeal to magistrates court (but prohibitions continue to have effect
Immediate
Section 59 Antisocial Behaviour Policing and Crime Act 2014
General – Public areas
Public space protection order Can be made where (a) activities carried on in a public place within the authority's area have had a detrimental effect on the quality of life of those in the locality, or (b) it is likely that activities will be carried on in a public place within that area and that they will have such an effect Can apply on a highway
District Council / Unitary Council
Significant process to implement including consultation.
Weeks
Health and Safety at Work Etc Act 1974 Section 22
Workplaces If as regards any activities to which this section applies an inspector is of the opinion that, as carried
Inspectors (either HSE or District Council / Unitary Council)
Need to link to the risk to staff, customers etc of infections.
Immediate
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Legislation Setting What it does Enforcing Authority Legal issues Timescale to implement
on or [likely] to be carried on by or under the control of the person in question, the activities involve or, as the case may be, will involve a risk of serious personal injury, the inspector may serve on that person a notice (in this Part referred to as “a prohibition notice”). Notice may take effect immediately
Licensing Act 2003 Section 51
Licensed Premises only
Review of Premises Licence, potentially either changing terms and conditions or revoking license based on Public Safety
Licensing Authority (District Council / Unitary Council)
Although it can remove licensable activities it does not prohibit other activity. So a shop could have its right to sell alcohol removed, but it would still be able to trade and sell milk, the impact is greater on premises which
Minimum period 1 month. However may secure voluntary compliance sooner
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Legislation Setting What it does Enforcing Authority Legal issues Timescale to implement
are fully reliant on licensed trade such as pubs
Licensing Act 2003 Section 53A
Licensed Premises only
Allows police to request licensing committee to suspend licence and have a review if premises associated with serious crime or serious disorder
Police/Licensing Authority (District Council / Unitary Council)
Would need to demonstrate ‘serious disorder’, which is a term not defined
Immediate subject to subsequent decision making / appeals
Health Protection (Local Authority Powers) Regulations 2010/657 Regulation 2
Education Requirement to keep a child away from school who is or may be infected
District Council / Unitary Council
Each child requires a separate notice to be served on the parents, lasts 5 days but may be renewed, note reg 3 allows for a notice to a Head teacher for information on pupils, allowing for contact tracing linked to this.
Immediate
Education Act 2002
Education Power for LA to give direction to governing body on health and safety
County Council / Unitary Council
None
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Legislation Setting What it does Enforcing Authority Legal issues Timescale to implement
grounds. Only applies to community or VC schools
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 12
Care Settings It is a criminal offence for regulated providers not to manage the risk of infection and the spread of it.
Care Quality Commission Retrospective Retrospective